Federalist 10 and Vending Machines: Why Democrats and Moderate Republicans Should Work Together to Improve the Affordable Care Act

I’ve said it before and I’ll say it again: Democrats should work with President Trump and Republicans in Congress to improve the Affordable Care Act. Doing so will result in more people getting more access to quality, affordable health care and it is in the political interest of everyone involved. It could also help steady a democratic system that is drunkenly lurching from one lamppost to the next and threatening to pass out in the gutter.

I work in politics to advance issues and ideas in which I believe, regardless of who is promoting them. The policies I support are more likely to advance if there are more Democrats in office, but the party label is a means, not an end. The point is the policy, not the party label. But of course politics matters. Saying that people who work in politics should put politics aside is like saying baseball players should spend opening day at a football game. People who hold elected office – politicians – have to think about politics to keep their jobs. If they didn’t think about politics they would be accountants, or parking attendants, or some other profession without the word “politic” in it.

If the Democrats want the political advantage that comes with being the party that finally got health care done, along with having the political advantage of being able to beat up anyone who wants to take health care away, to say nothing of having actually helped people, they need to give up partisan claims to the ACA. If the ACA is forever partisan, the law will never improve and we will never stop arguing about it, because anything to which one political party lays claim will be attacked by supporters of the other party. To win the policy of health care reform, Democrats have to let go of the politics of health care reform.

Ensuring access to affordable health care helps families, encourages entrepreneurs to launch new ventures, and is good for the federal budget. And it appears to be largely working. While the ACA is doing a lot of good, it isn’t perfect. Former senior Obama health official Andy Slavitt suggested some immediate steps the President can take. Other ideas were offered by health economist Austin Frakt. My favorite easy fix is eliminating the requirement for nutrition labels on vending machines – if you’re hitting a vending machine for nutrition, the problem isn’t the lack of a label. These are things on which everyone can work now. Failure to work on the policy of health care reform threatens to undermine many of the provisions of the existing law through legislative tweaks to weaken the bill, Executive Order, or the Trump Administration not supporting the law’s success. Bi-partisan progress can help people, and a lack of bi-partisan success may inevitably hurt people.

But of course the politics of the ACA matters. And the politics of working with Trump and Tuesday Group are good for the Democrats, good for moderate Republicans, and I would suggest good for the Republican Party and democracy in general.

Good for Democrats

The American people want their government to work. Many view political debate as a self-centered circus and pointless theater, even as evidence of the failure of democracy. The more Democrats bicker, the worse they look. If on the other hand Democrats become the party that says, “let’s fix what we agree on and talk about the rest later” they become party that wants to make government work. That Republicans are very much the public face of bickering makes this appeal possible. It may also have the effect of actually making the law better, more popular, less partisan, and harder to repeal. Democrats also need moderate Republicans to get anything done. Democrats are in the minority and likely will be for a while – the only path to policy success is through Republican cooperation. If politics is the “art of the possible” then Democrats need to perfect the art of working with moderates.

Good for Moderate Republicans

These Republicans may represent districts that have a lot of Democrats or face close elections. They need their voters to see real policy wins on real issues. Health care can be a win (“we got the Democrats to abandon Obamacare and are working on common-sense solutions that help families and small businesses…”). These Republicans will also reap the same “government is working” rewards Democrats reap.

Good for the Republican Party.

I miss the Republican Party that was stern but kind-hearted, the Party that valued hard work and humility and had nothing but scorn for public ranting. The Republican Party used to be the grown-ups. Now the Party appears to be torn between those few remaining grown-ups, and those who mistake being on TV for leadership and who think only in all-or-nothing terms. There is a shrinking cadre of thoughtful, pragmatic people who believe in governing and a growing group rushing to an Ayn Rand themed toga party. Unfortunately the grown-ups are losing elections and the Twitter ranters are winning. Unless the elements of the Party who think the point of government is governing start racking up some wins their days are numbered.

Good for Democracy

Democracy requires honest, smart, debate over policy differences. Our system requires serious disagreement to survive. Democrats and Republicans need reliable opponents whom they can trust and with whom they share a set of values (and agreement on facts). Our system is, in part, premised on competing factions. Unfortunately our federal legislative bodies more closely resemble the Battle of Verdun than a model deliberative body. Our system needs to prove to the people – and to itself – that it can work. “Tacking into the wind” on health care is a good place to start.

What of Trump?

If Congress crafts good health care bills that pass, Trump will sign them and declare victory. If Congress does not craft good health care bills that pass, Trump will blame everyone else and declare victory. Donald Trump accused the Speaker of the House for failing to repeal and replace the ACA before the vote was cancelled. He took to Twitter to attack some of his most vocal supporters in the House for killing repeal. He blamed Democrats for failing to pass a bill they had no part in and couldn’t have passed even if they had wanted to. Trump is pushing an agenda that will hurt his supporters more than anyone else. And he still says there will be great health care reform – even after a rumored revised AHCA came in with a whimper and went out with a sigh. If a truly bipartisan bill reaches the White House and Trump signs it, the Republican Party will be filming a video for Ballroom Blitz (as a Democrat that will be fun to watch). And if he fails to sign it the campaign ads write themselves. The mayhem could even help the Republican Party relocate its principled commitment to governing.

Partisan debates are important in democracy, but eventually those debates have to either be set aside or resolved. The health care debate is not going to be set aside, so it needs to be resolved, or at least move in the direction of resolution. There are other partisan debates to be had – if the ACA is the Democrats’ best rhetorical option going into 2018 the Party is in worse shape than anyone thought. This is an argument for advancing an argument, for making our democracy work. Doing so will help Democrats, help Republicans, the American people, and ultimately the system itself.